Sunday, March 27, 2011

Calorie Counting? Calorie Restricting? Or Simply Calorie Observant?

I had two wake up calls this past week, regarding the calorie content of foods.

Macarons stacked at La Duree, Paris.Typically French portions!
First, I walked into a local Starbucks and saw a new, and quite adorable, display of mini pastries. Maximum two-bites-sized, these charming micro cupcakes and nano whoopie pies had proudly displayed tags which announced their value, "190 calories".

And how did I feel? Well, quite mixed, to be honest. It was truly a reality check seeing the caloric value of such tiny pastries.  It was nice to see that in a small portion, delicious baked goods could fit as a snack for most anyone, calorie-wise. But how satisfied would I feel with something gone in only two bites, I wondered.

For some of you, it may feel good satisfying your taste from a controlled portion. For others, it might require a box of these cute, but oh-so-small delights. Do you label foods 'good' versus 'bad', 'allowed' versus 'forbidden'? Starbuck's strategy of displaying calories may actually help you, helping you to see that in a small portion, even calorie-rich items can fit in your diet.
Even without the calories listed,
can't you see these are small enough to include?

The second shock

I invited a teen patient of mine to bring in menus from the many restaurants he dines in weekly. Now here's the thing. Nutrition is my field, and I'm not naïve (you've noticed?). And yet when I examined the dinner entrees I was aghast. Single meals, for one person, with calorie counts around 2000! Saturated fat covering 3-4 days' allowance for health, sodium content in the 2000-3000 mg range, exceeding the recommended daily range for even healthy Americans (2,300mg/day, and 1500 mgs/day for those with high blood pressure). And that was just from a single meal.

Yes, even I was shocked. And also surprised by my own response; I was pleased to have that information available! And, to be able to share it with my patient, to enable him to be able to make a well-informed, healthier choice, from the entrees that appealed to him. Or, to be more mindful of his portions of such meals, if he chose to order one.

"But I thought you were against counting calories?"

I am. I am not in favor of adding up calories throughout the day, with a goal of limiting the total to a specific number. And, in doing so, likely deny your physical sensations such as hunger. Imagine you try to keep your intake to some (somewhat arbitrary) level. And by 5 PM you've reached your total. Yet your stomach is growling and you know that your body needs the fuel, the calories. Then what? See the problem? This calorie-counting method for weight control is not a perfect science. Even individuals of the same height will have differing needs. Those formulas that seem to calculate your daily requirement so scientifically are merely estimates, a ballpark figure, nothing more.

As for the calories on menus, here's another true patient story that helped shift my opinion.

I kid you not!

Jamie was a patient I worked with awhile back. She was overweight (without any eating disorder or disordered eating), and wanted to lose weight. Working as a manager at a non fast food restaurant chain, she had the luxury of ordering whatever she pleased from the menu (free, I might add). She just needed some guidance selecting wisely.

She showed me the menu, and unfortunately, there were few items that jumped out as healthy, to support her goal of weight loss. But the pasta primavera caught my eye, filled with veggies, not in a cheese sauce or alfredo. So I started there. As I recall it, this dish was described as containing a light sauce, made with wine. "Can't we just modify their portion of this dish?" I asked.

Not a chance, she smirked. "You know what goes into that dish?" she replied. An entire stick of butter, per plate! Yes, eight tablespoons. In my dreams (nightmares?) I would never have imagined it. Perhaps this sauce was light in color, but it's description failed to inform me of the richness of this meal.

Now if I had seen the menu with the nutrition info, it would have given me a heads up.

From L'Etoile, tops in Madison, Wisconsin!
No camera with me last night at Hamersley's Bistro!
So I'm a bit conflicted. I like having nutrition information available, but I feel it should be our choice whether we want to view it or not. Perhaps we could ask for the labeled menu, if we so choose. Just a thought. What do you think would be most helpful for your goals?

Last night, enjoying a celebratory meal dining in a lovely restaurant in Boston, the last thing I would've wanted to see next to the the pear galette (think buttery pastry) with ginger ice cream and a caramel sauce is the calorie value. Yes, my caloric intake for the day was certain to have exceeded the estimate by any equation. And so it was. I enjoyed every bit of my meal. And I don't eat like this daily. I shared this delectable dessert, and interestingly, was just comfortably full after my meal.

Ultimately, you may find it helpful to observe the calorie info on menus and on labels. It may help you choose between products, to help you meet your goal for weight regulation, particularly when you are just starting out. You may not trust your body just yet. But if you also focus on mindful eating (as described throughout this blog), and start to separate your physical hunger from all the other reasons you eat, you'll do much better. 

If you choose to use it, consider the calorie content as just one aspect of your eating. Choose what you enjoy, and try to use your body, and its fullness, as a guide.

Tuesday, March 22, 2011

Where Diet Apps Fail. Record Keeping That Shifts Your Perspective

The Wall Street Journal did a piece yesterday on diet apps, those free or modestly priced software programs for phones and mobile devices. Under the bold heading Counting Calories they stated:

“Certainly dietitians and nutritionists would say that keeping track of what you eat every day is a big step toward eating better and possibly eating less. But many of these apps go a step or two further.”

Here’s where their assumption falls short. Yes, tracking your intake makes you more aware and has a known benefit for weight management. But the apps tend to mislead you. In spite of their comprehensive database of foods and nutrition info (from the USDA), they are only as good as you are at honestly and accurately estimating your portions. And it is well established that we simply don’t do a very good job at this. In general, most individuals tend to significantly underestimate their food intake, while those who are underweight and those with anorexia tend to overestimate their food intake.

Often patients come in proudly displaying their high tech proof that their eating is in range. But a closer look reveals that their approximation of their portions was far from the mark, making this seemingly perfect app anything but.
More importantly, any nutrition professional that’s worth seeing is looking far beyond calories and counting. We are evaluating patterns of food intake, hunger ratings, and eating triggers such as stress, anxiety, boredom, misinformation, emotions, self-weighing and other influences. And for long-term weight management, we are looking at clients’ perceptions of their eating and the negative and positive impact that has on subsequent meals and snacks.

Take a look at what I read on Sharon’s food record last week:

“I hate eating breakfast! It makes me hungrier the rest of the day.”
“Weighing myself—a big mistake!”
“I am so fat and shouldn’t have eaten so much this week.”
“I’m starving.”
“I blew it. May as well keep eating.” 

“What’s wrong with me? Why can’t I stop eating?”
“I feel awful and super fat!”
“Binged. Not even hungry, just want to eat. I’m stressed and feel fat anyway.”
“Ate a small salad and feel even fatter.”
“Triggered by therapy. It always makes me want to binge and purge. I know it’s wrong but it helps me relax.”
“I don’t want to eat but I just can’t stop thinking about food

Now what do you imagine Sharon’s food record looked like? Full of true binges, out of control, excessive feeding frenzies? Multiple items, or very large quantities of a single item, like cookies, ice cream, even cereal? Forbidden foods, generally, but not necessarily. In fact, her eating may have been fully ‘controlled’. It may have even been planned, a not uncommon occurrence. She may hate it, but plan to binge anyway, perhaps with the intent of getting rid of it. Or not.  The eating feels out of control, but ironically it is something she may have very much decided when and how to do.

But that was not what I read on Sharon’s food record last week. Her pages were filled not with surplus calories from binges, but with voids—calorie-free diet beverages, salads with fat-free dressings, coffees and “light” products. More than a report about her food, it revealed the most about the distortion in her thinking.

And had we only looked at an app’s analysis, perhaps the totals wouldn’t have appeared too bad. But the pain and the struggle keeping her stuck in this cycle would certainly be overlooked.
Identify with Sharon? Hoping to get past this place, but petrified, so you stay stuck? Consider this: If keeping things the same isn’t working, you may as well take the risk and try something different.
Now, back to Sharon’s comments.

Why the full feeling? If you’ve gone through a period of severe restriction, or have been purging, you likely are experiencing fullness when eating. And it’s not just in your head. These behaviors result in slowed movement of food through your digestive tract. It takes longer for food to move through, so yes, you will feel full longer. But the feeling passes, doesn’t it? Take note of how long the discomfort lasts. For most, it starts to feel better after about 40 or 45 minutes.

Why so hungry? Could be that the fullness was a temporary fix, not due to adequate or excessive calories. A 2-liter bottle of Diet Coke will make you feel full, stomach full. You’ll likely feel bloated, with a distended stomach. Yet it contains no calories. No fuel to serve your body. And so the feeling passes and then you’re left starving.

Or maybe you purge and then get hungry again later. You’re so focused on how much you ate, that you minimize that you got rid of much of your food. Of course your body is looking for fuel and signals that you are hungry!

Perhaps you really ate frequently throughout the day. But how adequate were those meals or snacks? Did they only look adequate? Were the portions large in volume, but low in substance? Did you omit fats from your diet, leaving you hungry soon after eating?

Aren’t you being unfair, expecting to subsist on so little, and beating yourself up when that strategy fails you?

Sharon has a long way to go. But at least now she is including food, multiple times, in the daytime. This is a giant shift from her old pattern of going all day without eating, followed by a binge and a purge. At least now she manages to get through some days with a more adequate intake, with neither a binge nor purge. At least she is seeing her potential. At least she is starting to shift her perspective.

Yes, these photos were taken by me, in my kitchen. But not while eating!
Her thinking does remain distorted—in part because she is still starved. Small changes won’t cure that immediately. Sharon’s got to push herself further out of her comfort zone to start to see things more clearly. And she needs to learn other ways to tackle her anxiety, versus sticking with what is familiar—her eating disorder.

As for those apps—if they truly want to have an impact and “go a step further”—they should allow for self-reporting hunger levels, moods, distractions while eating and thoughts. Then users could bring them to their visits with an experienced professional. And yes, an RD with a behavioral focus would be a great place to start!

Perhaps you have a different perspective? Care to share it? Please leave me a comment below!

Saturday, March 19, 2011

Normal Eating Taken Too Far?

Learning to accept a less-than-perfect diet
Soon after entering practice as a Registered Dietitian back in the 1980s, I stumbled upon the most brilliant piece on eating, written by Ellyn Satter. It is timeless, and full of wisdom. So I wanted to share it with you and to share my thoughts on it.
“Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.” Copyright © 2010 by Ellyn Satter.
(For more about eating competence (and for research backing up this advice), check out Rights to reproduce: As long as you leave it unchanged, you don't charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to
I vividly recall first reading this and being a bit shocked. “Give yourself permission to eat sometimes because you are happy, sad or bored…”?! That seems to fly in the face of what we should be doing to manage our eating and our weight! But then I took a closer look. The key word in this sentence is sometimes. Because even mindful eating isn’t all or nothing. 

Yes, we are trying to move toward better matching our body’s need for fuel, for food, with what we feed it, based on our physical hunger. But we are only human. And sometimes we eat just because the food is there. Or, because there is something to celebrate. And sometimes we eat because it is our familiar way of comforting ourselves. And sometimes we eat, even overeat, knowingly, because we haven’t yet learned how to sit with distress. So we go to what is familiar in order to get by, to cope.

Archery has never been my thing. In fact, I never even heard of it growing up in Brooklyn, New York. But here’s an analogy that provides a visual that somehow I could relate to. To manage our eating, we are moving toward trying to hit a bull’s eye on a target. That center circle, that scores the most points, is our goal. But starting off, we may never have even noticed that a target existed. Perhaps we didn’t even have the right tools. (There were no bows and arrows in my neighborhood growing up.) We didn’t even know which direction to aim for, to shoot in. And so the potential damage was great.

With some awareness, we may see the target, but it may take a lot of practice to even hit the outer ring. And that would be progress. But we need to continue to work at it.  To assist, we need to remove distractions around us that steal our focus. Taking lessons and observing from those who have mastered it before us further improves our skill. We need to appreciate how far we’ve come—to recognize that now we’re at least hitting a ring, versus the feeling of chaos of random shooting-as opposed to focusing on the fact that we haven’t hit dead center yet. And, to have the patience until we finally reach even that point.

And we need to believe in ourselves, and to get support from others who believe in us. And as we continue to practice, we will begin to trust our bodies and ourselves. We will learn, as Ellyn Satter states, that it’s okay to give yourself permission to eat what you enjoy and that even if you overeat sometimes, your body, believe it or not, is forgiving.

As always, I welcome your thoughts!

Friday, March 11, 2011

Fat Free-dom. Fats Don’t Make You Fat!

And other lessons from the new 2011 Dietary Guidelines

Who knows what to believe any more. One day, you’re told to lower your intake of fats, all fats, and another you are told to increase omega 3 fats, because they’re healthy. Margarines—the spread of choice? Perhaps in my parents’ generation, but not these days. Now they are equated with poison in our bloodstream, full of trans fats, those plastic-like substances worse than saturated fats. Fatty fish are fine, but fatty meats are not. Nuts? Peanut butter? Avocado? Good for us? Or fattening?

If these questions have overwhelmed you, like most of the public trying to make sense of the ever-changing nutrition guidance, read on.

Like carbs, fats have developed a bad rep. Partly, for good reason, I might add. Compared to protein and carbohydrate, they have more than twice as many calories per unit. Yes, 9 calories per gram versus 4 calories per gram. And over the years, in an effort to lower high cholesterol and heart disease risk, nutrition messages became inaccurately oversimplified. Saturated fats remain linked with high cholesterol and heart disease risk. But in our effort to reduce the saturated fats, somehow the “saturated” got dropped, and the message became “eat a low fat diet”. 

Well guess what? That message backfired. Even with a reduction in saturated fats, heart disease levels remained high. The problem was that we were substituting fats, all fats, with carbohydrate, with high intakes of refined carbohydrate. Remember the post Why Carbs Got a Bad Rep? As you may recall, when people started banning fats, they were eating large quantities of carbohydrate from all sources. This diet led to higher levels of triglycerides, another risk factor for heart disease.

Feeling like you can’t win? There is a solution.

The message needs to change from eat low fat, to eat less saturated fat. And, we need to increase the non-saturated fats we’ve omitted from our diets for the past years. Our current approach isn’t working—not for heart disease prevention, and not even for weight management.

Yes, you heard me. A low fat diet doesn’t improve your weight, compared with a higher fat diet with the same amount of calories.

The 2011 Dietary Guidelines For Americans

Why should I now trust this source of nutrition information when I have been wronged before?

First some background info. These guidelines come from the top nutrition experts in the US who form committees every five or so years to update us on the facts. They are not paid by food companies, so no need for that paranoia. Any personal interests must be disclosed, to prevent bias in their conclusions. They do a complete review of the research, eliminating the studies that are poorly done or not statistically valuable. Each group of experts tackles a specific nutrition area, such as fats, to address a range of questions related to the type and amount, as it impacts our health. Weight and heart disease are among the topics explored.
Then they analyze the results of the combined studies, the most up to date information available, and present us with the Dietary Guidelines for Americans. So yes, they are quite trustworthy.

And what do these results about fats say?
The full report can be found at, but here’s a summary with quotes from the report:

Eating fat doesn’t make you fat

“Strong evidence shows that there is no optimal proportion of macronutrients (protein, fat, carboydrate) that can facilitate weight loss or assist with maintaining weight loss." It all comes down to the total calories. "In adults, moderate evidence suggests that diets that are less than 45 percent of total calories as carbohydrate or more than 35 percent of total calories as protein are generally no more effective than other calorie-controlled diets for long-term weight loss and weight maintenance.”

Fats should not just be tolerated, but included for health!

“Fats supply calories and essential fatty acids, and help in the absorption of the fat-soluble vitamins A, D, E, and K. Acceptable ranges for total fat intake for children and adults allow for a total fat intake up to 35-40% in children (depending on age) and up to 35% for adults.
These ranges are associated with reduced risk of chronic diseases, such as cardiovascular disease, while providing for adequate intake of essential nutrients. Total fat intake should fall within these ranges.”

Increase the typically low intakes of healthy mono and unsaturated fats in your diet!

“The types of fatty acids consumed are more important in influencing the risk of cardiovascular disease than is the total amount of fat in the diet.
Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Keep trans fatty acid consumption as low as possible, especially by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.”

Translating it into foods

“Animal fats tend to have a higher proportion of saturated fatty acids (seafood being the major exception), and plant foods tend to have a higher proportion of monounsaturated and/or polyunsaturated fatty acids (coconut oil, palm kernel oil, and palm oil being the exceptions).

Most fats with a high percentage of saturated or trans fatty acids are solid at room temperature and are referred to as “solid fats,” while those with more unsaturated fatty acids are usually liquid at room temperature and are referred to as “oils.” Solid fats are found in most animal foods but also can be made from vegetable oils through the process of hydrogenation....”

Include oils such as canola, olive, walnut, sunflower, safflower and corn. Choose lean meats, but include fatty fish, whose fat is not saturated. Choose foods that are full flavored, to allow for more modest portions, for the sake of energy balance and weight management. Nuts and nut butters, avocado, and oils are healthy, but should be eaten mindfully to control portions and total calories.

My personal favorites

I love walnut oil ( and have recently needed to work more hours to support my truffle oil habit. Absolutely divine! I love good cheese, the full fat types, but yes, they are high in saturated fat. So I grate them, cheeses like Asiago and Manchego, rather than add thick slabs onto my entrées. I choose strong cheeses, and dark chocolate, because a little goes a long way to satisfy. As a result I could keep my saturated fat intake in range, without compromising on flavor. And trust me, I never feel deprived.
If you are still overwhelmed by the idea of adding fats to your diet, start slowly. Add a small amount of nuts or a tasty oil just to test it out. When you see that your worst fears don’t come true, you’ll start to trust these guidelines. Because even though the word is the same, fats don’t make you fat!

Tuesday, March 8, 2011

Recovery Happens. But Not Without Your Help.

Statistically, she was likely to fail. She had a long-standing eating disorder, and was well entrenched in her 31 year of thoughts and behaviors. She lacked motivation to change, and continued to live in a toxic environment, from a recovery standpoint. And quite frankly, her eating disorder worked for her. 

Yes, you read that correctly. While unhealthy and quite dangerous, ED helped Cathy on many levels. It was her drug of choice, so to speak. It numbed her, allowed her to live invisibly, and allowed her to have no expectations for herself.  If you only knew the details of Cathy’s life, you wouldn’t be judging her for her choice.

That is, if it were a choice. She was not the first generation of her family to live with an eating disorder. Genetics? Environmental? A combination? There’s no quick answer, but likely a combination of factors result in developing an eating disorder, and in maintaining it.

Cathy’s began at the age of 16. Yet she first presented to me at the age of 37. Her only experience with ED treatment was at her 3 hospitalizations, the last one just prior to seeing me, a stay prompted by her suicidality. Hardly enthused about recovery—never mind being there, she presented to my office only to please her therapist (with the consequence of losing her if she failed to show).

This was no quick fix, and in truth, the battle isn’t fully won—yet. She’s had great support from her therapist, moving forward not just in her relationship with food, but her ability to begin to advocate for herself. It hasn’t been easy—for either of us—but it is so satisfying to read her unprompted words below. So I just had to share. Cathy would never frame her amazing recovery as her accomplishment. But there’s still time to work on that in therapy! Hope you feel inspired by Cathy’s shift, occurring over a 3 year period.

"I've been so sick - literally laying in bed for most of the week).  I managed the hell day yesterday of consuming only liquids and endured the copious amounts of Gatorade and Miralax (prepping for the colonoscopy).  You were right, the test was fine - knocked out cold for both tests - but it was the prep that was not so. 

How in the world did I use this whole laxative thing before???  It's just awful and I actually hate it!  I can't believe I would use laxatives!!!  I am never, ever going to use them again - and this only reminded me of why I wouldn't want to use them again!  Also, let's talk about barely eating --- how in the world did I manage that one too????  I couldn't tell you how damn hungry I was all yesterday!  

Am I that far removed from ed that I am soooo out of practice by barely eating anything?  I was dragging, unenergetic, blah blah blah.  I was unable to finish the last 2 glasses of the Gatorade blend (so I cheated) but they didn't say anything about it today (thought I was going to get spoken to!)  I was so close to throwing up the end of that Gatorade, I absolutely wanted to throw up my stomach hurt so much from that, so it was a fight (even putting my hands in front of my mouth) not to puke it up.  I decided it's better if I skip some than throw up all I had. 

I wanted to share these thoughts with you, and why?  Because I was just reminded of how lousy I feel when I'm ingesting laxative pills, and barely eating anything.  It sucks!  And I guess it reminded me that also that after days of being sick, then topped off with yesterday's recipe of clear liquids and Gatorade, I just want to feel well!  

Maybe this is me saying I am liking feeling healthy.  I am hoping tomorrow morning this sickness will be gone, and I'll be able to fill my tummy with coffee and wheat toast - and even a morning snack!  I want energy back!  I guess I appreciate better health more than I thought."

Friday, March 4, 2011

Easy-On-Your-Conscience Banana Bread

Gotta love that golden brown.
There’s creating good food. And there’s managing the food. This post will help you to achieve both. 

My yummy banana bread recipe combines great taste, ease and a baked good you can feel good about eating. It has little saturated fat, and it’s a great value—you get a decent portion, and a great deal of pleasure, for the calories. Enhance with the addition of nuts or ground flax for omega 3’s and fiber, or a handful of chocolate chips (just because). It’s great either way. Trust me, I’ve made every possible combination over the years.

Yes, I went for the added nuts! But it's great without, too.
As for managing around such a delectable baked good? First, allow it to cool. Then slice it into ten evenly cut slices. Don’t do this when you’re hungry! And do it when you’re not alone! Wrap each slice, first in plastic wrap, then in foil. For those more environmentally sensitive, skip the foil and place all individually wrapped slices into a Ziploc bag. Place in the back of the freezer, so it’s not the first thing that catches your eye when you’re looking for the chicken.

Decent size, especially on this little plate, no?

Ready to try a piece? Place it on a small plate, and microwave reheat. Sit at the table, in the kitchen or dining room, perhaps with a cup of tea or milk, and enjoy! Shut the TV, remove the newspaper (and the kids), and eat it with all your senses!

Easy-On-Your Conscience Banana Bread
(10 servings)


The more ripe the sweeter, allowing less added sugar.
Pam, or other oil spray
2 Tbsp unsalted butter
2 Tbsp olive or canola oil
¼ cup honey
¼ cup sugar
2 large eggs
3 large bananas,
very ripe, almost rotten, mashed
1½ cups all-purpose flour
½ tsp baking soda
½ tsp salt
Love my Kitchen Aid. But hand mixing works fine for this!
(1/2  cup walnuts, pecans, ground 
flax or chocolate chips, optional)
Preheat oven to 350 degrees.

Spray a bread pan (12 X 4 ½ X 2 ½) with an oil spray.
Combine the wet ingredients and blend thoroughly.

If mixing by hand, separately mix the dry ingredients.
It took 65 minutes in my oven. But start with 60.
Add dry ingredients to wet ones. 
Bake for 1 hour. Test for doneness using a toothpick or skewer (if it comes out wet, bake for another 5 mins and retest).

For those on meal plans, 1 slice counts as 2 grains and 1 fat serving.


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